Frances Bavin Fitness ParQ

Physical Activity Readiness Questionnaire (PARQ)

It is recommended that all participants complete a PARQ before taking part in an exercise class. The information will be completely confidential and not shared with anyone. It will be deleted after a year if the client doesn't return.

If your medical situation changes then the instructor needs to be updated.

If you answered YES to one or more questions:
You should consult with your doctor to clarify that it is safe for you to become physically active at this current time and in your current state of health.

If you answered NO to ALL the questions:
It is reasonably safe for you to participate in physical activity, gradually building up from your current ability level. A fitness appraisal can help determine your ability levels.

By submitting this questionnaire you agree that you have understood and accurately completed it and confirm that you are voluntarily engaging in an acceptable level of exercise and my participation involves a risk of injury.

If I have answered YES to one of the questions above, I agree to seek medical advice if I haven't done so already and my GP has agreed that I may exercise.

Please contact francesbavinfitness@gmail.com with further information if necessary.

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* 1. Client Name & Date of Birth

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* 2. Address

Name

Address

Address 2

City/Town

ZIP/Postal Code

Country

Email Address

Phone Number

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* 3. Has your doctor ever said that you have a heart condition and recommended only medically supervised activity?

Yes

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* 4. Do you have chest pain brought on by physical activity?

Yes

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* 5. Have you developed chest pains in the last month?

Yes

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* 6. Do you tend to lose consciousness or fall over as a result of dizziness?

Yes

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* 7. Do you have a bone / joint problem or previous injury that could be aggravated by the proposed physical activity?

Yes

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* 8. Has a doctor ever recommended medication for blood pressure or a heart condition or do you take medication?

Yes

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* 9. Are you pregnant or have you been pregnant in the last 3 months?

Yes

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* 10. Do you know, through your own experience or doctor's advice, of any other physical reason why you should not exercise without medical supervision?

Yes